Mental Illness and the ‘Medical Theodicy’ Trap

Five years ago I received a telephone call from a friend. She told me that one of our mutual friends had taken his own life. No one knew why.

Brian was a successful health-care professional, with a wife, a family, and an apparently very bright future. Many of us had not seen any indications that something was wrong, although those in close contact with him knew there were problems. He just got up one morning and was never seen alive again. Everyone was devastated.

What do you do with such news? One of the most painful human experiences must be to say goodbye to a loved one in the morning and then never see that person alive again. I was asked to do the sermon at the celebration of Brian’s life. I preached on the psalms of lament and the unending, unfailing love of God. I tried to help people see that the joy that God promises includes suffering and that the psalms of lament offer faithful language to express our hurt, brokenness, anger, and disappointment at what my friend had done and what God had seemingly not done: save him.

Two Affirmations

Brian was a Christian; he was a lover of Jesus, as were his family and many of his friends. And yet, despite the profound consolation of the gospel, for some, the first response to his death by suicide was not comfort but fear. In spite of the apostle Paul’s firm assurance that “neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord” (Rom. 8:38–39), they were afraid for Brian’s eternal future. I guess that is the problem with hypercognitive theologies that assume that our eternal futures lie in our own hands rather than in the loving hands of God. If it is the case that neither death nor life can separate us from God’s love, then we need not fear death, even death by suicide. We simply need to trust in God’s grace.

There is a difficult tension between recognizing that God does not abandon those who end their own lives and the imperative that such actions are not God’s desire for human beings. As Duke Divinity School theologian Warren Kinghorn once reminded me, two affirmations are indispensable for a Christian approach to suicide:

1. Suicide is a tragedy and a loss, and never to be encouraged or seen by Christians as a positive good.
2. Nothing will be able to separate us from the love of God in Christ Jesus our Lord.

If we Christians say either of these things without the other, we fall into error. My sermon at Brian’s funeral tried to capture the complex dynamics of these two statements. The lament psalms articulate the reality of tragedy and loss alongside the reality of God’s unending love. Such an approach does not take away our pain, but it does provide us with a certain kind of consoling hope. I think people were helped by that sermon.

But then something changed.

The autopsy results came back, and it turned out that Brian had had a problem with his pituitary gland that may have contributed to his depression and ultimate demise. Some people seemed strangely relieved when they heard this. “Ah! It wasn’t really his mind. It was his body that had gone wrong.”

Now, that may have been the case, but there are two things to consider as we reflect on this reaction. First, the spiritual dualism is quite startling. If his death has something to do with Brian’s mind, then it is a spiritual problem, but if it has to do with his body, it is a medical issue. Second, and connected to the first point, it is interesting how medicine became, for some, a therapeutic theodicy, a way of explaining the presence of perceived evil and suffering. If the problem lies within the human psyche, and if the human psyche is the place where we determine our salvation, then Brian has a real problem. But if the issue is biological, then medicine can explain it without the need for awkward questions around the nature of God and the meaning of human suffering.

One of the problems for modern Western people is the tendency to equate the soul with the mind. Culturally we place inordinate social value on intellect, reason, quickness of thought, and academic ability. Certain strands of theological thinking can be sucked into this hypercognitive trap when defining emphasis is placed on intellect and verbal ability, with the verbal proclamation of the name of Jesus assumed as a central and vital aspect of our salvation. When we think like this, any damage to the mind implicitly or explicitly morphs into damage to the soul.

This can make it particularly difficult for Christians to live well with mental health challenges, brain damage, or something like dementia. The implication that the real problem is soul damage prowls around like a roaring lion. The palpable sense of relief that some of my well-meaning Christian friends expressed as they encountered a medical theodicy is but one instance of a cultural phenomenon that is, to say the least, troublesome.

A Liberating Language

Fast-forward five years to a few months ago. I had just flown from Aberdeen to London and was walking toward the airport exit when a man I had never met before stopped me. “You’re John Swinton?” he said. Now, I can never be certain whether to own up to a question like that! But on this occasion I did. He said, “You spoke at Brian’s funeral five years ago. I just want to thank you. I had never thought of suffering and joy in that way, and I had certainly never thought that it was OK to be angry with God and to speak out that anger and frustration through the psalms. I just wanted to say thank you.” With that he walked on.

I left the airport and got on a train to central London. As I thought about that brief encounter, I began to realize that the problem that many people encountered when Brian took his life was that they were speechless. His friends had no effective language to articulate the pain, lostness, and indeed anger that they felt toward the situation and in many ways toward God. They had become monolingual in their faith lives, sure and confident in the language of happiness and hope, but completely lost when it came to the language of suffering, brokenness, disappointment, and in particular, a biblical understanding of joy.

They had heard Jesus say: “Very truly I tell you, you will weep and mourn while the world rejoices. You will grieve, but your grief will turn to joy” (John 16:20), but they had not experienced the illumination of his words. This lack of language led them to turn to medicine and biology for intellectual and spiritual relief. They turned to them as theodicies not just because they alleviated fears about Brian’s eternal destiny but because they spoke in a language with which they were familiar. Medicine and biology represented a safe place. Within their theological tradition, they couldn’t find the right kind of language to articulate their feelings and fears. The language of medicine and biology filled the gap.

What the stranger in the airport taught me was that the words of my sermon had given him a language to express his sadness, his pain, and his anger, and that this language came from within his faith tradition in a way that he had not noticed previously. My articulation of the power of the psalms had moved him from silence into speech. I had helped him to reframe both lament and joy.

By understanding the nature and purpose of joy, we can understand depression in a different way, and that will give us a way to talk about depression (and to remain silent) that is both liberating and, I hope, healing. Understanding depression through the lens of Christian joy can help us understand depression more thickly and respond more faithfully.

John Swinton is professor of practical theology and pastoral care at the University of Aberdeen in Scotland and the founding director of the Centre for Spirituality, Health and Disability. He is the author of Finding Jesus in the Storm: The Spiritual Lives of Christians with Mental Health Challenges (Eerdmans), from which this essay is adapted.

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